What led to their success, so far?
RYE BROOK, NY– Out of the recent round of 27 ACOs accepted to the Medicare Shared Savings program, nine were partnered with Collaborative Health Systems (CHS), a subsidiary of Rye Brook, N.Y.-based Universal American.
How did CHS, a consulting firm, help hospitals and physicians across the country prepare to participate in ACOs? Tony Wolk, senior vice president and general counsel for CHS and Kirk Clove, president of CHS, explains:
"Unlike other payers, we have a long history of working with providers," Clove says. Prior to forming CHS, Universal American shared data with participating physicians and collaborated with them on ways they could improve care.
CHS's ACO partners are located in New York, Texas, North Carolina, Georgia, Mississippi and Wisconsin, ranging from closely connected medical groups to broadly dispersed IPAs. The smallest physician practices are from 25 to 30 with the larger ones totaling more than 100, according to Clove.
Wolk says the biggest challenge in establishing the ACOs was in the logistics. CHS's ACOs began working on collecting data prior to the CMS release of ACO regulations. The easiest part has been partnering with the doctors.
"We’re credible, having done this for years," Wolk says. "Doctors know we care about what's in their best interest."
Creating a technology platform was challenging in the beginning, Wolk says. "We wanted to create a platform they could all use," he says. The most surprising aspect of the start-up ACOs, Wolk says, was how few providers have readily accepted EHRs.
"With many of the doctors without EHRs, we had to think of other ways to communicate," he says. "I’d like to say that it’s a perfect world where everyone has an exchange, but that requires philosophy and cultural changes. The stimulus funding hasn't been enough to get some doctors to make the change.”
Without everyone on board with EHRs, one of the ways CHS has collected data is through claims data. They looked for gaps in procedure and diagnosis codes.
As Wolk sees it, this is not as ideal as real-time decision support. It requires the physicians to reach out and get the information.
"We try to get staff to look at the patient data before a patient comes in for a visit, to see if something has been overlooked in the patient's treatment," Wolk says.
It has helped that many of the ACOs partnered with CHS are on the NextGen platform, he says. CHS has offered subsidies for doctors who would like to get started with EHRs, as long as they adopt NextGen. The subsidies are in the form of CHS fronting the stimulus money to doctors, who then pay CHS back when they earn meaningful use incentives.
Clove says CHS has not stopped with the initial nine ACOs. The consultants plan to have more healthcare providers apply to the program in July and next January.
Clove and Wolk attribute some of CHS's success with ACOs to the willingness to be first.
"We were one of the first participants in the Part D Program. It continues to evolve, and we learn as we go, Clove says. "We're comfortable with the way that turned out."
Wolk agrees that ACOs were part of the unknown.
"A lot of people sat on the sidelines because of the ambiguity in the process, but we began to act immediately. We felt comfortable enough having been through the experience before. You can’t sit and wait for it to be perfect."
All in all, "ACOs are a good petri dish for developing healthcare innovation into the future," Wolk says. "They inspire the sharing of information.